Integrated Second Language Learning for Chronic Care: An Intervention to Improve Nursing Care for Hispanics with Diabetes ABSTRACT Language barriers in healthcare are recognized as a leading determinant of health disparities among Hispanics in the United States.1 Limited English proficiency (LEP) has also been linked to the soaring diabetes epidemic among Hispanics. For Hispanics, the prevalence of type 2 diabetes mellitus (DM2) is 1.5 times that of non- Hispanic whites.3 Hispanic patients who do not speak English at home are at greater risk of foregoing diabetes care and they are significantly less likely than non-Hispanics to adopt a special diet for diabetes control, to exercise regularly, and to receive a yearly eye examination.6, 3 Recent research suggests that language concordance (LC) between patients and primary care providers is an effective precondition that improves outcomes in the treatment of LEP patients with diabetes. Interventions to increase the number of LC nurse practitioners consist of educational programs that develop second language (L2) abilities for health care professionals. A review of extant literature on L2 training for health professionals revealed that the preponderance of programs and materials are directed at basic levels of proficiency and confined to limited types of clinical interactions. The view of he present research team is that these programs and materials are substantially geared towards acute care and reflect a mismatch between an LEP patient population with chronic illnesses and a health professional workforce trained in L2 for acute care functions. This mismatch, we contend, exacerbates the difficulties faced by LEP patients with diabetes in achieving successful self- management and the physical and emotional wellness that goes along with it. This proposal describes the design and evaluation of an innovative educational intervention for nurse practitioner students called Integrated Language Learning for Chronic Care (IL2L). It pursues an integrated development of L2 and communication skills that will facilitate productive interactions between Spanish-speaking nurse practitioners and LEP Hispanic patients with diabetes. A mixed-method study design will be used to examine the preliminary efficacy and acceptability of the intervention. At the patient level, we will employ an RCT to determine the impact IL2L on the physical health, mental health, and self-efficacy of patients with uncontrolled diabetes. At the student level, we will employ the Roter Interaction Analysis System to measure gains in Spanish language interaction skills pre and post intervention. At the program level, we will use language program evaluation methodologies to assess the acceptability of the intervention within a nurse practitioner training program in a leading College of Nursing.